Study protocol for evidence-based LIFEstyle interventions for the delay of COgnitive DEcline among Singaporean older adults (LIFECODES): a randomized controlled trial

Background Singapore’s rapidly aging population has led to a widening gap between total and healthy life expectancy. Dementia affects approximately 10% of adults aged ≥ 60 years, and 152,000 people are projected to be living with dementia by 2030. Up to 45% of dementia cases may theoretically be prevented or delayed by addressing 14 modifiable risk factors across the life course. However, evidence on clinically effective, culturally tailored multidomain interventions for older Singaporeans remains limited. The LIFEstyle interventions for the delay of COgnitive DEcline among older Singaporean adults (LIFECODES) trial evaluates the effects of a multidomain lifestyle intervention on cognitive decline and the added value of individualized health coaching. Secondary aims examine epigenetic aging and systemic inflammation. Methods LIFECODES is a three-arm proof-of-concept randomized controlled trial at the National University of Singapore (NUS) aiming to enroll 120 community-dwelling adults aged 60–75 years with signs of cognitive decline. Participants are randomized to group-based health education (GHE), GHE plus individualized health coaching (HC), or general care. The two-year intervention comprises 27 in-person sessions addressing eight lifestyle domains relevant to dementia risk: diet, physical activity, cognitive activity, social engagement, mental well-being, sleep, smoking and alcohol consumption. The primary outcome is cognitive processing speed. Secondary outcomes include memory, executive function and other cognitive domains, DNA methylation (DNAm) age, inflammatory biomarkers, functional status, psychosocial well-being, and sleep quality. Interim Results As of 14 September 2026, 190 individuals had been screened, and 110 (57.9%) met the eligibility criteria. Seven eligible individuals withdrew before randomization and 12 withdrew after randomization. A total of 91 participants are currently enrolled in the study (GHE, n = 30; HC, n = 30; control, n = 31). The first rolling intervention cohort began on 15 May 2025. Among the 91 participants, the mean age is 68.7 years (SD 4.2), and 66 (72.5%) are female. Recruitment and follow-up remain ongoing. Conclusion Interim recruitment and randomization indicate that a community-based multidomain dementia-prevention trial can be initiated in Singapore. Planned analyses will determine intervention efficacy and the added value of individualized health coaching for cognitive health and biological aging. Clinical trial registration https://clinicaltrials.gov/study/NCT06661486 , identifier NCT06661486.